Apparatus and method for minimally invasive surgery

ABSTRACT

A single body port or body flange access device and method for performing laparoscopic surgery are disclosed. The device comprises a plurality of crisscrossing conduits through which surgical instruments may be inserted. The instruments are manipulated so that triangulation is obtained using one patient body flange while standard surgical procedures are performed on the patient.

This application claims the benefit of priority of U.S. ProvisionalApplication Ser. No. 60/779,136, filed on Mar. 3, 2006.

TECHNICAL FIELD OF THE INVENTION

This device and method relate to laparoscopic surgical procedures and inparticular to an improved device and method for minimally invasivesurgical procedures.

BACKGROUND OF THE INVENTION

Minimally invasive surgery has improved patient care by decreasing pain,shortening hospital stays, offering a faster recovery time and muchsmaller scars. In fact the surgical procedure is much shorter thanstandard procedures and offers less chance of infection, etc. Theselaparoscopic procedures are proving popular with the patient.

During minimally invasive procedures for the abdominal surgeries suchas:

-   -   laparoscopic appendectomy (removal of the appendix);    -   laparoscopic cholecystectomy (removal of the gallbladder);    -   laparoscopic colectomy (removal of part or all of the colon);    -   laparoscopic fundoplication (corrects severe or persistent acid        reflux);    -   laparoscopic hysterectomy (removal of the uterus); or    -   laparoscopic ventral hernia repair (repair of an abnormal        bulging of the abdominal wall often at the site of a previous        surgical incision),        the surgeon makes a series of three to five small, dime-sized        incisions in the patient's abdomen. Carbon dioxide gas is used        to inflate the abdomen and create a working space between the        internal organs and the skin. A small video camera, or scope,        then is placed in one of the incisions, providing the surgeon        with a magnified view of the patient's internal organs on a        television monitor in the operating room. In some procedures,        like MIP for colon conditions, a slightly larger incision may be        needed.

Thus, the procedure requires body access devices, which are utilized tointroduce visualization equipment and operative instruments rather thana standard incision to access a required part of the body. Nonparallelinstrumentation is necessary to create a “depth of field” (3-dimensionalvision) and introduce a variety of instrumentation. This concept iscommonly known as triangulation.

In past multichannel devices have been used by the surgeon using narrowparallel channels (within the single multichannel access device). Thesenarrow parallel channels have been found to limit the field of view andreduce depth perception. Thus, multichannel devices have not met theneeds of the surgical community and are rarely used.

Nonparallel multiple access devices would allow the surgeon to introducenumerous types of instruments with triangulation through one body accessopening. This concept would preserve triangulation and create therequired field and depth of view while allowing the surgeon to utilizeone body flange for multiple simultaneous tasks, which would be requiredto complete an operation on any applicable body area or space.

The current state of the art utilizes entry devices (body flanges) thathave a similar cross-section as a silver dollar and incorporate acontrol head (gas in fusion port and sealing systems for insertablesurgical instruments that have almost double cross-section as the partof the flange that attaches to the abdominal wall or body entry port.This means that large incisions will be used when operating on obesepatients to allow for the large control head.

Wilk in U.S. Pat. No. 5,183,471 discloses a “Laparoscopic Cannula” thathas a central conduit with a side crossing conduit that passes throughthe central conduit thereby creating an obstacle within the centralconduit. The disclosure teaches a means to facilitate the temporaryinsertion of an extra laparoscopic instrument without having to makeanother perforation of the abdomen. The side crossing conduit willrequire that the central conduit be large; otherwise, a standardinstrument would not be able to pass through the central conduit. Thecentral conduit will allow a surgical instrument to “look” verticallydownward over the operation point while the side crossing conduit willpass an instrument to one side of the operation point. Wilk continues toteach a second body flange for illumination and vision and does notdiscuss triangulation.

Wilk in U.S. Pat. No. 5,269,772 discloses a “Laparoscopic CannulaAssembly and Associated Method” which essentially is two parallelswiveling conduit passing through the same body opening and is acontinuation-in-part of his '471 disclosure examined above. The parallelconduits do not cross over each other; however, the device will allowone instrument to be to one side of the operation point while the otherinstrument may be to the other side. The swiveling assembly will requirea rather large opening in the abdomen wall. As in his '471 disclosure,he continues to teach a second body flange for illumination and visionand does not discuss triangulation.

Yoon in U.S. Pat. No. 6,066,090 discloses a “Branched Endoscope System”which discusses a single body flange having a plurality of tubes passingthrough the conduit for various surgical instruments. Yoon shows anembodiment in which the inside section of the body flange splits in twoparts each having a bend thereby allowing a tube to overlook the othertube. The Yoon '090 device is designed to pass through the current artbody flange having a single conduit.

Yoon in U.S. Pat. No. 6,277,064 discloses a “Surgical Instrument withRotatably Mounted Offset Endoscope.” The apparatus is a variation of the'090 device and is designed to pass through the current art body flangehaving a single conduit.

Wenner et al. in U.S. Pat. No. 6,440,061 disclose a “LaparoscopicInstrument System for Real-Time Biliary Exploration and Stone Removal.”This device has multiple ports within its system, but, like Yoon, isdesigned to pass through the current art body flange having a singleconduit.

Bimbo et al. in U.S. Pat. No. 6,551,270 disclose a “Dual Lumen AccessPort.” The device is essentially a current state of the art body flangewith parallel entry ports that open into a single conduit which willaccept two surgical tools through one body flange without ensuring athree dimensional field of view. Bimbo teaches multiple instrumentsthrough a single conduit but does not explore the concept of a singlebody flange replacing surgical procedures using multiple body flanges.

Thus, what is needed in the art is an apparatus and method that wouldallow the surgeon to perform minimally invasive operations with bodyflanges having a smaller overall cross-section while allowing fortriangulation within the patient. Such a device and method will resultin with fewer incisions for body access openings thus further decreasingthe pain caused by surgery and further decreasing the recovery time andfurther reducing the risk of infection.

SUMMARY OF THE INVENTION

The invention consists of a “body flange” or “trans-axis-uniport”(“TAU”) which is anchored to the body with a standard suture anchoringpoints. In turn, the body anchor contains a crisscrossed plurality ofconduits which allow nonparallel introduction of equipment and/orinstruments. The conduits may be parallel, nonparallel, straight orcurved, but enter the body through one body opening. (It may benecessary during some procedures to have additional body openings.)

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1 and 2 show the body access openings required for a laparoscopicappendectomy as practiced in the current art.

FIGS. 3 and 4 show the body access opening required for a laparoscopicappendectomy as practiced in the instant invention. Note how the twoports (which may be multiple) cross each other providing a field ofview.

FIG. 5 shows a close up view of the current state of the art bodyanchor.

FIG. 6 shows the body anchor of the instant invention showing how theconduit apertures cross over within the anchor.

FIG. 7 shows a dual straight conduit embodiment of the instantinvention.

FIG. 8 shows a dual conduit embodiment of the instant invention havingone straight conduit and one curved conduit.

FIG. 9 shows a dual curved conduit embodiment of the instant invention.

FIG. 10 shows the body anchor of the instant invention illustrating astandard suture tiedown.

FIG. 11 shows the body anchor of the instant invention illustrating oneform of a v-notch suture tiedown.

FIG. 12 shows the instant invention with the v-notch suture tiedownincorporated in one of the conduit outside walls.

FIG. 13 shows the instant invention embedded in the abdomen wallillustrating a suture tiedown passing into the abdomen wall andreturning to the suture tiedown point incorporated into the outside wallof a conduit.

FIG. 14 shows the dual bent conduit embodiment of the instant inventionas utilized in an obese patient. Note the small cross-section affordedby the bent conduit structure.

FIG. 15 shows the parallel aperture embodiment of the instant invention.

FIG. 16 shows how the dual curved conduit embodiment of the instantinvention with surgical instruments clearly illustrating the threedimensional triangulation obtained through the instant invention.

FIG. 17A shows an alternate embodiment of the body anchor havingcrisscrossed apertures with a central straight aperture.

FIG. 17B shows an alternate embodiment of the body anchor havingcrisscrossed apertures with a central straight aperture, but showing oneof the larger crisscrossing apertures as being curved.

FIG. 18A is a diagrammatic cross-sectional view of the instantinventions showing how the apertures “crisscross” within the bodyanchor.

FIG. 18B is a diagrammatic top view of the instant device showing howthe crisscrossed apertures align the surgical instruments so thattriangulation is readily obtained.

FIG. 19A is a diagrammatic cross-sectional view of a first example ofthe prior art of Wilk.

FIG. 19B is diagrammatic top view of the first example of the prior artshowing how the surgical instruments are offset.

FIG. 20A is a diagrammatic cross-sectional view of a second example ofthe prior art of Wilk.

FIG. 20B is diagrammatic top view of the second example of the prior artshowing how the surgical instruments are offset.

DESCRIPTION OF THE PREFERRED EMBODIMENT

In reading this disclosure, the reader should understand that the termbody flange generally means the entire device used to temporarily sealan incision in a patient. Thus, the body flange would include the bodyanchor—the section of the device that fits within the abdominal wall andis temporality sutured to the abdominal lining, any passagewaysextending through the body anchor (both above and below), any seals orother apparatus that is required to form the complete temporary entryclosure.

Refer now to FIG. 6 which shows an oblique view of the body anchor, 1,of the instant invention. The invention comprises of two crisscrossed(non-parallel) apertures, 2 and 3, passing through the body anchor. FIG.14 shows an alternate embodiment in which two parallel apertures, 5 and6, pass through the body anchor, 1. Not shown are the standard sutureanchor points or tiedowns on the anchor.

FIG. 7 shows the complete body flange utilizing the straight instrumentconduit, 11 and 12, embodiment. Not shown are required seals within theconduits, which are similar to the current art and serve to retain thebody inflation gas while various instruments are inserted and withdrawnthrough the body flange during the operation. Such a representative sealis shown in FIG. 4 of U.S. Pat. No. 6,551,270, which is incorporated byreference. Similarly the standard inflation gas port(s) is not shown. Arepresentative gas port is shown in FIG. 1 of U.S. Pat. No. 6,440,061which is incorporated by reference. The '061 patent also discusses gasseals.

FIG. 8 shows an alternate embodiment of the instant invention utilizingone straight conduit, 13, and a curved or bent conduit, 14. FIG. 9 showsa further embodiment of the instant invention utilizing two curvedconduits, 15 and 16.

FIGS. 3 and 4 and FIGS. 6 through 14 and FIG. 16, detail thecrisscrossed nature of the longitudinal axis of each conduit passingthrough crisscrossed apertures within the body flange. This is thepreferred invention because the preferred mode allows for readytriangulation of instrumentation (as explained below). It is possible toobtain triangulation with parallel apertures as shown in FIG. 15 andthus parallel apertures (with guiding conduit) are considered within thescope of the instant invention.

FIGS. 13 and 14 show cross-sectional views through the body of theinstant device used in the illustration of FIGS. 3 and 4. FIG. 13 showsthe embodiment of FIGS. 7 and 12 (both conduit being straight) used in anormal person. A single suture is shown running through the abdominallining and passed back up to the notch, 22: this suture holds the bodyflange, 1, in place during the operation. The second required suture isnot shown (for clarity) but will also terminate in the notch. Thetechnique is similar to the current state of the art. (It is possible tomanufacture a system having a second notch—not shown—on the otherconduit.)

FIG. 10 shows an alternate suture “tie post” or tie-off, 21, based onthe prior art.

Because the body anchor is so small only one post is required, but thesuture requires a guide, 26, to stop the two sutures from sliding aroundthe circumference of the plug.

FIG. 14 shows the noticeable advantage of the instant device when usedin obese persons. FIG. 14 shows the embodiment of FIG. 9 in which bothconduits are curved. The crisscross occurs within the body flangeitself, but because the curved conduits, 15 and 16, pass over and besideeach other on the outside (of the flange) the resulting cross-sectionremains the same as the cross-section of the body flange or at worstonly slightly larger. Thus, the incision size is substantially reducedover the current art. Again, a suture is run through the abdominallining and passed back up to the notch, 24: this suture holds the bodyflange, 1, in place during the operation. (Only one of two sutures isshown for clarity.) Note that an anchor using the suture post of FIG. 10may be substituted for the notches, 23 and 24.

FIG. 16 shows the instant device in use with surgical instruments. Thestraight instrument, 36, represents a standard instrument and the bentinstrument, 35, simulates a flex scope with a bend. The bend serves onlyto illustrate how the surgical instruments function together: whilestill being independent. For simplicity the term instrument is used todesignate the actual medical (surgical) instrument that is passingthrough the conduits of the body flange of the instant invention. Theterm flex-scope is the standard adjustable video scope used in surgicalprocedures. FIG. 16 shows suture notches, 22 and 24. This is for thepurposes of illustration only as only one such notch is required;furthermore the tie post, 21, and guides, 26 of FIG. 10 may besubstituted.

The size of the flex-scope can vary and is set by the number ofinstrument channels within the flex-scope. The important and keyinstrument is the bendable flex-scope shown in the figure cross coupledwith a standard instrument (or flexible instrument) so that a threedimensional view is obtained and maintained during the procedure. The“bendable” channel houses the optics used in the laparoscopic procedure(camera and illumination). Note that due to the bendable channel theoptics will provide a field of view that approaches that of a threedimensional view of the surgical area.

FIG. 17A is a further embodiment of the body anchor showing thecrisscrossed apertures along with a third aperture, 4, that will place asurgical instrument midway inline with the instruments using the otherapertures, 2 and 3.

FIG. 17B is similar to FIG. 17A; however, the drawing shows one thecrisscrossing apertures, 3, as being curved. The curved aspect of theaperture is probably the best manner to actually build crisscrossingapertures within the anchor and the curve will serve to better guideinstruments through the enclosed conduit (the conduit that passesthrough the crisscrossing apertures). FIG. 17B really serves toillustrate the best mode to make the crisscrossing apertures; although,the actual shape (curved or straight) will be set by the style ofinstrument to pass through the conduit/aperture pair.

Although not shown, it is possible to incorporate a rotable seal withinthe apertures of the body anchor which would allow the conduit to rotatewith respect the anchor and to themselves. This would then aid invectoring surgical instruments for triangulation.

FIGS. 1 and 2 shows the current art using a plurality of canula orinstruments. Port 1 (P1 in FIGS. 1 and 2) is equivalent to the singleport (P1) in FIGS. 3 and 4. The crisscrossed conduits (TAU) of theinstant invention serve the same function as ports 2 and 3 (P2 and P3)in FIGS. 1 and 2—the prior art. One of the conduits serves to allow theoptics to enter the surgical area while the other conduit serves toallow for additional instruments. Note how the field of view gives athree dimensional effect (so that distance can be judged by the surgeon)is obtained with the single port using the instant invention as comparedto three (or more) ports of the prior art.

FIGS. 3 and 4 show clearly how the flexible channel (flex-scope) servesthe same function as the canula of ports 2 and 3. Some surgicalprocedures only need two ports (for example P1 and P2) thus; FIG. 16shows a direct replacement for this procedure. On the other hand, mostprocedures required three points of access as shown in FIGS. 1 and 2(for example P1, P2 and P3) thus; FIG. 16 shows a direct replacement forthis procedure. The bendable flex-scope holds the optics and providesone or more additional channels for instruments. It should be noted thatthe second instrument may also be bendable.

It should be noted that FIGS. 1 through 4 imply a laparoscopic appendixoperation. Referring now to FIG. 4 and single port P1, if something goeswrong during the laparoscopic procedure (e.g. a burst appendix) and thenormal procedure has to be performed, port P1 need only be extended forthe surgeon the “fall-back” to the standard appendectomy.

To use the device, the surgeon would carefully choose the position ofthe single port opening. The choice is relatively simply. The singleport opening must allow for proper cross-over of the instruments so thata three-dimensional view of the surgical area of interest is obtained.The surgeon makes the incision using standard techniques inserts theinstant device, sutures the device in place and runs the flex-scope andrequired instruments through the appropriate conduit in the device.Standard and proven techniques are then used to perform the surgery.Closing is standard.

FIGS. 18A and 18B show how surgical instruments when passed through theconduit which are crisscrossed within the body anchor will automaticallyalign along a straight line within the body. This means that thesurgeon, as the instruments are inserted, mentally knows how theinstruments are aligned and the triangulation required for depthperception is guaranteed. FIGS. 19A, 19B, 20A, and 20B show how therequired guaranteed triangulation cannot be obtained. Thus a single bodyflange, which can be extremely small compared with the current art, canbe used to guarantee the required triangulation for depth perception.

What has been disclosed is an apparatus and method for an improvement tominimally invasive (laparoscopic) surgery. The technique shown uses onebody flange in a single body opening; however, a second body opening isnot outside the scope of the method and apparatus. The preferred modeusing crisscrossed conduits has been described; however, parallelconduits and even a combination of crisscrossed and parallel conduitsare envisioned. The conduits themselves which pass through the aperturesof the body plug guarantee triangulation for depth perception within thebody flange.

1. A multiple access body flange assembly for performing minimallyinvasive laparoscopic surgery on a body comprising: a body access anchoradapted to be anchored to the body; a first aperture; and, a secondaperture; wherein both said first and second apertures passing throughsaid body access anchor whereby when surgical instruments are passedthrough said apertures such instruments may be manipulated by thesurgeon so that a triangular field of view is obtained.
 2. The device ofclaim 1 wherein said first apertures crisscrosses, within said bodyanchor, said second aperture.
 3. A multiple access body flange assemblyfor performing minimally invasive laparoscopic surgery on a bodycomprising: a body access anchor adapted to be anchored to the body;and, a plurality of apertures passing through said body access anchorwherein when surgical instruments are passed through said apertures suchinstruments may be manipulated by the surgeon so that a triangular fieldof view is obtained.
 4. The device of claim 3 wherein at least one ofsaid plurality of apertures crisscrosses, within said body anchor,another one of said plurality of said apertures.
 5. The device of claim2 wherein said anchor has a top side and an underside said undersidefurther comprising a first conduit and a second conduit wherein saidfirst conduit passes through said first aperture and said second conduitpasses through said second aperture and wherein said conduit extendabove said top side of said anchor.
 6. The device of claim 3 whereinsaid anchor has a top side and an underside said underside furthercomprising a plurality of conduit wherein each of said plurality of saidconduit pass respectively through one of said plurality of apertures andwherein said plurality of conduit extend above said top side of saidanchor.
 7. The device of claim 5 wherein one or more of said conduitextending above said top of said anchor are curved such thecross-section of said conduit is minimized thereby reducing thecross-sectional size of the required incision in the body.
 8. The deviceof claim 6 wherein one or more of said conduit extending above said topof said anchor are curved such the cross-section of said conduit isminimized thereby reducing the cross-sectional size of the requiredincision in the body.
 9. The device of claim 5 further comprisingsealing means adapted to retain body inflation gas.
 10. The device ofclaim 6 further comprising sealing means adapted to retain bodyinflation gas.
 11. The device of claim 5 further comprising gasinjection means for addition of body inflation gas.
 12. The device ofclaim 6 further comprising gas injection means for addition of bodyinflation gas.
 13. The device of claim 5 further comprising rotable sealmeans with said anchor such that one or more of said conduit may berotated with respect to said anchor thereby aiding in the positioning ofsurgical instruments passing through said conduit.
 14. The device ofclaim 6 further comprising rotable seal means with said anchor such thatone or more of said conduit may be rotated with respect to said anchorthereby aiding in the positioning of surgical instruments passingthrough said conduit.
 15. The device of claim 5 further comprisingsuture attachment means located on said top side of said anchor.
 16. Thedevice of claim 6 further comprising suture attachment means located onsaid top side of said anchor.
 17. The device of claim 5 furthercomprising suture attachment means located on one or more or saidconduit.
 18. The device of claim 6 further comprising suture attachmentmeans located on one or more or said conduit.
 19. A method employing amultiple access body flange assembly having a plurality of crisscrossingconduits in laparoscopic surgery comprising: a) creating a singleincision on the body by carefully considering the area where the surgerywill be performed within the body; b) inserting the multiple access bodyflange through said incision thereby temporarily closing the incision;c) inserting two or more required surgical instruments through one ormore of said plurality of conduit; d) manipulating the instruments sothat triangulation is obtained; e) performing the required operation;and, f) following standard procedures for closing and terminating theprocedure.
 20. The method of claim 19 wherein one or more of saidplurality of conduits are rotablely mounted within the body flange andwherein step d) is substituted by the following step: dd) manipulatingone or more rotable conduit and manipulating the instruments so thattriangulation is obtained.